Health Policy Center AuthorsPublications by Stephanie Maxwell for Health Policy Center Back to Browse by Author More about Stephanie Maxwell's areas of expertise can be found on this Urban Institute expert's page.
Use of Physician Services under Medicare's Resource-Based Payments (Occasional Paper) Author(s): Stephanie Maxwell, Stephen Zuckerman, Robert Berenson This paper demonstrates that while fees for physician evaluation and management increased over the first ten years of the Medicare Fee Schedule, the quantity of imaging services and non-major procedures increased even more, making the share of program spending on evaluation and management services in 2002 the same as it was in 1992. Two factors explained the differential spending growth across types of services: the introduction of new services and the process for reviewing and revising fees. The authors argue that differences in expenditure growth across service types affect Medicare's costs and should be considered in the program's spending control policies.
Options for Improving Medicare Payment for Skilled Nursing Facilities (Research Report) Author(s): Korbin Liu, Bowen Garrett, Douglas A. Wissoker, Stephanie Maxwell, Andrew Kramer, Theresa Eilertsen, Anne Epstein, Yu-Chu Shen, Sung-Joon Min, Sharon K. Long, Robert Schlenker, Brant Fries, Joan Buchanan Medicare has paid skilled nursing facilities (SNFs) using a prospective payment system (PPS) since 1998. This report offers policy options to refine Medicare’s payment of SNF services by developing alternative patient classification models. Three models classify patients according to expected non-therapy ancillary (NTA) costs: two models use data from the SNF to model NTA costs; a third adds data from prior hospital stays. A fourth model predicts rehabilitation therapy costs using patient characteristics. The fifth uses Diagnostic Related Groups to predict total SNF care costs. The report also simulates options for outlier payments for exceptionally high-cost cases.
Reconsidering Geographic Adjustments to Medicare Physician Fees (Research Report) Author(s): Stephen Zuckerman, Stephanie Maxwell This paper provides policy analysis of the geographic adjusters used in the Medicare physician payment system. In 2003, Medicare set a floor on the adjuster for the work component of each fee so that every area is paid at least at the average, regardless of its relative costs. We review the conceptual foundation for the geographic practice cost adjusters, emphasizing why researchers and policymakers included an adjustment for geographic differences in the costs of physicians' work. Finally, we discuss the floor provision in the context of the broader aims of its proponents—to increase access to physician services in those areas affected by the floor.
The Direct Payment Method for Medicare Managed Care Plans (Research Report) Author(s): Jack Hadley, Marilyn Moon, Stephanie Maxwell, Stephen Zuckerman This concept paper extends and develops an idea for an alternative methodology Medicare might use to determine capitation payments to health plans that participate in the Medicare+Choice program. The Direct Payment Method, first suggested by Greenwald et al. (1998), would shift the basis of payment away from the current approach, which builds on county-based Medicare fee-for-service (FFS) expenditures, to a national model that predicts expenditures for individual Medicare enrollees. Ideally, the Direct Payment Method would use detailed encounter data for Medicare+Choice enrollees, information on the cost of the services they received, and a health-based risk adjuster to predict expenditures for individual enrollees. When combined with geographic adjustments for input prices and local market conditions, the resulting payment would be independent of the extreme and highly problematic geographic variations in Medicare's FFS payments per enrollee.
Long-Term Care Hospitals Under Medicare (Article) Author(s): Korbin Liu, Cristina Basseggio, Douglas A. Wissoker, Stephanie Maxwell, Jennifer M. Haley, Sharon K. Long Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs. . (Health Care Financing Review 2001 Winter; 23(2):1-18).
Long-Term Care Hospitals Under Medicare (Article) Author(s): Korbin Liu, Cristina Basseggio, Douglas A. Wissoker, Stephanie Maxwell, Jennifer M. Haley, Sharon K. Long Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs. (Health Care Financing Review 2001 Winter; 23(2):1-18).
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